University of Pennsylvania Health System Shares Best Practices for Maintaining Professionalism Among Faculty at an Academic Medical Center

Professionalism Committee-based Approach is Key to Management of Disruptive and Inappropriate Behaviors

PHILADELPHIA — A Professionalism Committee (PC)-based approach has proven to be a successful and effective way to define and manage unprofessional behavior among physicians, according to a study from the University of Pennsylvania Health System (UPHS) as detailed in the April 2014 issue of The Joint Commission Journal on Quality and Patient Safety. The authors suggest that the model could be replicated by hospitals across the U.S. to handle scenarios involving issues such as workplace bullying and disruptive behaviors.

The Joint Commission Leadership Standard, effective in 2009 mandates that, “Leaders create and maintain a culture of safety and quality throughout the hospital.” This was updated in 2013 to require that “Leaders develop a code of conduct that defines acceptable behavior and behaviors that undermine a culture of safety, and create and implement a process for managing behaviors that undermine a culture of safety.” This mandate spurred hospitals and health systems across the country to develop policies and programs to address these long-ignored issues in medicine.

“At UPHS we developed a program that meets our needs in both structure and function,” says Lee Fleisher, MD, chair of the UPHS Credentialing Committee, chair of Anesthesiology and an author on the paper. “Our approach gives authority to the professionalism committee chair to sort out issues and conflicts promptly, unimpeded by bureaucracy in a structure that we believe is replicable by other institutions. It has provided faculty with the tools to address unprofessional behavior before it has a detrimental effect on patient care.”

The central tenet of the UPHS model is the Professionalism Committee, with one established at each of the teaching hospitals that make up UPHS with reporting to each respective Medical Executive Committee.

The PC chair, a psychiatrist, is the first point of contact for department chairs when a behavioral issue arises. The PC chair gathers information from the offending faculty member’s department chair and if need be, conducts a one-on-one meeting with the faculty member to discuss the incident. The chair then recommends next steps, which can include: no intervention, recommendation for treatment (cognitive behavioral therapy or psychotherapy), executive coaching, further evaluation; or referral to the Medical Executive Committee for formal investigation The PC chair makes a recommendation to the department chair as to next steps, and the department chair sees to it that the faculty member follows the outlined program.

Often, individuals are unaware of how their behavior might impact patient satisfaction, quality or patient safety. By bringing it to their attention, most physicians are able to self-correct,” says Jody Foster, MD, MBA,Professionalism Committee Chair and chair of Psychiatry at Pennsylvania Hospital of UPHS.
“Having a psychiatrist at the helm of our program allows us to identify and address the role of behavioral health in unprofessional behavior early on in this process,” says Fleisher.

In complicated incidences with many parties involved, the full Medical Executive Committee may be convened for fact-finding purposes. And, in certain very serious cases, the Medical Executive Committee will engage the Credentials Committee for a formal investigation and action.

Prior to the professionalism committee approach, risk reduction initiatives included the creation of the Office of Patient Affairs, which captures patient feedback on all aspects of the medical care experience and participation in the Patient Advocacy Reporting System (PARS), a system of data collection and analysis to address physicians with high levels of patient dissatisfaction and promote professional accountability.

New initiatives are also underway to underscore the importance of professionalism and accountability among the professional staff. For example, the Penn Medicine Academy of Master Clinicians now recognizes clinicians who exemplify the highest standards of patient care and professionalism and gives these faculty members the authority to work with the department chair and leadership on strategies to improve the culture of clinical excellence and promote the ideal patient experience. In addition, the Office of Faculty Affairs and Professional Development is developing a curriculum for faculty in their first year, with the expectation of professionalism as one of the key topics.

“These programs are a great example of the commitment of our clinical and administrative leadership to improve outcomes and reduce harm,” adds Patricia Sullivan, PhD, vice president of Quality and Patient Safety.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.